| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5664 PRAIRIE CREEK DR SE CALEDONIA, MI 49316 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $12K | $7K | $20K | 11.04% |
| ENROLLEASE3 | 660 YORK STREET SUITE 102 SAN FRANCISCO, CA 94110 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 1.17% |
| DAVID O CHRISTENSEN3 | 180 MCKNIGHT DRIVE LAGUNA BEACH, CA 92651 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9K | $1K | $10K | 7.78% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA SHOREPOINT INSURANCE SERVICES COSTA MESA, CA 92626 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7K | $43 | $7K | 5.18% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F FAHEY LLC | 9301 33RD ST NW DORAL, FL 33172 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $796 | $3K | 2.36% |
| BRIAN YERVANT AKIAN3 | 503 SPRINGBROOK NORTH IRVINE, CA 92614 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $384 | $3K | 1.96% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $602 | $2K | 1.72% |
| USI INSURANCE SERVICES LLC3 | 21700 OXNARD ST SUITE 1200 WOODLAND HILLS, CA 91367 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 0.89% |
| GOLD RIVER FINANCIAL GROUP LLC3 | 2807 GRATTON ST RIVERSIDE, CA 92504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $933 | $109 | $1K | 0.81% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DRIVE BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $687 | $224 | $911 | 0.71% |
| SHERRI BARHAM3 | 24694 PASEO DE TORONTO YORBA LINDA, CA 92887 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $683 | — | $683 | 0.53% |
| ERIC ALEXANDER NOVOA3 | 17871 SHADY VIEW DR CHINO HILLS, CA 91709 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $421 | $95 | $516 | 0.40% |
| ELTHON ISRAEL CRUZ3 Filed as: ELTHON ISREAL CRUZ | 244 S 1200 E PAYSON, UT 84651 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $341 | — | $341 | 0.26% |
| JOHANA HERMILA MEDINA3 | 12365 RIVER OAKS DR RANCHO CUCAMONGA, CA 91739 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $289 | $11 | $300 | 0.23% |
| ERIC TERRAZAS3 | 217 LOIS ST LA HABRA, CA 90631 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $184 | — | $184 | 0.14% |
| JOHN D EVANGELISTA3 | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $86 | $43 | $129 | 0.10% |
| NISSAH LIA AGUILAR3 | 33556 MAPLEWOOD CT TEMECULA, CA 92592 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $107 | — | $107 | 0.08% |
| JUSTIN INGLE3 | 26661 VIA SACRAMENTO CAPISTRANO BEACH, CA 92624 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $104 | — | $104 | 0.08% |
| MARIA YVONNE RODIGHIERO3 | 28502 SHRIKE DRIVE LAGUNA NIGUEL, CA 92677 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $92 | $5 | $97 | 0.08% |
| LAMBERT MONTALBO3 | 26197 MIRADA ST HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $68 | — | $68 | 0.05% |
| LIFE TIME SOLUTIONS LLC3 | 861 KENWOOD ST UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $68 | — | $68 | 0.05% |
| ARIAN E NAWABI3 | 201 DARLINGTON IRVINE, CA 92620 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $61 | — | $61 | 0.05% |
| CONSUMER DRIVEN BENEFITS LLC3 | 3737 BIRCH ST NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $35 | $25 | $60 | 0.05% |
| DAVID A. RACKLIFFE3 Filed as: DAVID A RACKLIFFE | 300 HEROIT CT SPRING HILL, TN 37174 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $47 | $1 | $48 | 0.04% |
| DEL DOWNEY3 | 32056 MERLOT CRST TEMECULA, CA 92591 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $45 | $2 | $47 | 0.04% |
| TIM CHRISTOPHER ELLIS3 | PO BOX 483 ORANGE, CA 92856 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $45 | — | $45 | 0.03% |
| TINA HERNANDEZ3 | 11779 W COCOPAH ST AVONDALE, AZ 85323 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $35 | — | $35 | 0.03% |
| JENNIFER AURORA RAMIREZ3 | 1053 FICUS LANE SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $30 | $4 | $34 | 0.03% |
| CURTIS ALBERTO CANETT3 Filed as: CURTIS ALBERO CANETT | 21901 JINETES MISSION VIEJO, CA 92691 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | — | $12 | 0.01% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 2405 SATELLITE BLVD DULUTH, GA 30096 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.01% |
| KLD INSURANCE BENEFITS INC3 | 9085 BETHEL RD GAINESVILLE, GA 30506 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.00% |
| VIRGINIA LEDER-CLARK3 | 4513 BRINDLE WAY FLOWER MOUND, TX 75028 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.00% |
| NORMAC SOLUTIONS INC3 | 451 HOPKINS ROAD TOWNVILLE, SC 29689 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| MPART BENEFITS INC3 | 4621 GLEN HEATHER DRIVE FRISCO, TX 75034 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| TINA HERNANDEZ3 | 11779 W COCOPAH ST AVONDALE, AZ 85323 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $530 | $3K | 46.15% |
| DAVID O CHRISTENSEN3 | 180 MCKNIGHT DRIVE LAGUNA BEACH, CA 92651 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $222 | $2K | 22.86% |
| MICHALE F FAHEY II3 | 9301 33RD ST NW DORAL, FL 33172 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $359 | $185 | $544 | 7.99% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | DBA SHOREPOINT INSURANCE SERVICES COSTA MESA, CA 92626 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $439 | $5 | $444 | 6.52% |
| ERIC ALEXANDER NOVOA3 | 17871 SHADY VIEW DR CHINO HILLS, CA 91709 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $359 | $80 | $439 | 6.45% |
| BRIAN YERVANT AKIAN3 | 503 SPRINGBROOK NORTH IRVINE, CA 92614 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $46 | $9 | $55 | 0.81% |
| CONSUMER DRIVEN BENEFITS LLC3 Filed as: CONSUMER DRIVER BENEFITS LLC | 3737 BIRCH ST NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | $19 | $46 | 0.68% |
No Schedule C service providers reported on this filing.
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 266 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 268 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | AETNA HEALTH, INC. | 240 | $1.7M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 237 | $178K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 237 | $178K |
| Life insurance(3 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 237 | $313K |
| Short-term disability(2 contracts) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 161 | $136K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 237 | $178K |
| Other(3 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 237 | $313K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 240 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
No prospect flags tripped on this filing.